Stereotactic Radiosurgery for Vestibular Schwannomas: A Survey of Current Practice Patterns of Neurotologists

Objective: To evaluate the use of radiation by neurotologists practicing in the United States as a treatment modality for vestibular schwannomas (VSs). Study Design: Cross-sectional survey. Methods: We surveyed 302 members of the American Neurotology Society to assess the number of VS seen, the frequency with which radiation is used as a treatment modality, radiation training and experience, the impact of tumor size and patient age on treatment decisions, and radiation dose ultimately used by neurotologists. Results: Responses were received from 43% (132/302) of surveyed neurotologists; of the respondents, 42% (54/132) perform stereotactic radiation. Approximately 58% (30/54) of those use gamma knife, and 44% (24/54) use Cyberknife; 36.7% of VS patients seen by neurotologists received radiation. On average, 6 additional neurotologists per year begin treating VS with stereotactic radiation. Academic and private neurotologists showed significant differences (p < 0.05) between new VS patients per year, years in practice, and maximum tumor size recommended for radiation. The most common barrier to using radiation was prevention by a neurosurgical or radiation oncology service. Neurotologists use radiation to treat other cranial base tumors as well, most commonly glomus tumors or meningiomas, and 64% of respondents irradiate neurofibromatosis Type 2. Total radiation dose and fractionation were variable. Conclusion: Neurotologists are increasingly choosing to treat VS with stereotactic radiation. There seem to be significant differences between academic and private neurotologists' practice characteristics. Not all neurotologists strictly adhere to the consensus statement by the International RadioSurgery Association with regard to radiation dosing and tumor size limits.